To identify common challenges and best practices for onboarding, training, and integrating APPs in an academic department of neurology by understanding the experiences of current APPs.

Integrating APPs into neurological practice can improve access, assist in education and management of patients, reduce system costs, and alleviate physician burnout. APPs receive sparse training in neurology during formal education, so on-the-job training is essential. Nationwide standards for training informed by the needs of APPs themselves are lacking.

We conducted a focus group with current APPs practicing within an academic neurology department. Eight of nine APPs participated (six PAs, two NPs). We explored their diverse roles in multidisciplinary teams, challenges faced during their onboarding and training, and strategies for success. Inductive qualitative content analysis was performed to identify key themes.

Only two participants had a required neurology rotation during schooling and three had previous work experience in neurology. In their current job, APPs served diverse roles including caring for hospitalized and ambulatory patients, performing procedures, assisting trainees, and performing research. Participants uniformly acknowledged a lack of educational resources tailored to graduating APPs. Neuroanatomy, neuroimaging, and generating a differential diagnosis were key knowledge gaps identified. Shadowing, self-directed learning, and supervised graded clinical responsibility were identified as essential for successful onboarding and integration. Additional challenges included physicians’ misperceptions of APPs’ knowledge base and experience and patients’ uncertainty regarding APPs’ role and expertise. APPs desired more structured educational opportunities and peer-to-peer mentorship.

The common challenges and success strategies identified can inform the design of a formal curriculum for onboarding neurology APPs applicable to diverse practice environments. Our findings suggest an optimal APP training process should involve shadowing and graded responsibility, employ peer mentors, and target the multidisciplinary team: physicians require training on APPs’ knowledge base and patients require education on the role of APPs.